|File:US Navy 040421-N-8090G-001 Hospital Corpsman 3rd Class Flowers administers chest compressions to a simulated cardiac arrest victim.jpg
CPR being administered during a simulation of cardiac arrest.
|Classification and external resources|
|Patient UK||Cardiac arrest|
Cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is a sudden stop in effective blood circulation due to the failure of the heart to contract effectively or at all. Medical personnel may refer to an unexpected cardiac arrest as a sudden cardiac arrest (SCA).
A cardiac arrest is different from (but may be caused by) a myocardial infarction (also known as a heart attack), where blood flow to the muscle of the heart is impaired. It is different from congestive heart failure, where circulation is substandard, but the heart is still pumping sufficient blood to sustain life.
Arrested blood circulation prevents delivery of oxygen and glucose to the body. Lack of oxygen and glucose to the brain causes loss of consciousness, which then results in abnormal or absent breathing. Brain injury is likely to happen if cardiac arrest goes untreated for more than five minutes. For the best chance of survival and neurological recovery immediate treatment is important.
Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. Unexpected cardiac arrest can lead to death within minutes: this is called sudden cardiac death (SCD). The treatment for cardiac arrest is immediate defibrillation if a "shockable" rhythm is present, while cardiopulmonary resuscitation (CPR) is used to provide circulatory support and/or to induce a "shockable" rhythm.
A number of heart conditions and non-heart-related events can cause cardiac arrest; the most common cause is coronary artery disease.
- 1 Classification
- 2 Signs and symptoms
- 3 Causes
- 4 Diagnosis
- 5 Prevention
- 6 Management
- 7 Prognosis
- 8 Epidemiology
- 9 References
- 10 External links
Clinicians classify cardiac arrest into "shockable" versus "non–shockable", as determined by the ECG rhythm. This refers to whether a particular class of cardiac dysrhythmia is treatable using defibrillation. The two "shockable" rhythms are ventricular fibrillation and pulseless ventricular tachycardia while the two "non–shockable" rhythms are asystole and pulseless electrical activity.
Signs and symptoms
Cardiac arrest is sometimes preceded by certain symptoms such as fainting, fatigue, blackouts, dizziness, chest pain, shortness of breath, weakness, and vomiting. The arrest may also occur with no warning.
When the arrest occurs, the most obvious sign of its occurrence will be the lack of a palpable pulse in the person experiencing it (since the heart has ceased to contract, the usual indications of its contraction such as a pulse will no longer be detectable). Certain types of prompt intervention can often reverse a cardiac arrest, but without such intervention the event will almost always lead to death. In certain cases, it is an expected outcome of a serious illness where death is expected.
Also, as a result of inadequate cerebral perfusion, the patient will quickly become unconscious and will have stopped breathing. The main diagnostic criterion to diagnose a cardiac arrest (as opposed to respiratory arrest which shares many of the same features) is lack of circulation; however, there are a number of ways of determining this. Near-death experiences are reported by 10–20% of people who survived cardiac arrest.
Coronary artery disease is the leading cause of sudden cardiac arrest. Many other cardiac and non-cardiac conditions also increase one's risk.
Coronary artery disease
Approximately 60–70% of SCD is related to coronary artery disease, also known as ischemic heart disease. Among adults, it is the predominant cause of arrest, with 30% of people at autopsy showing signs of recent myocardial infarction.
Non-ischemic heart disease
In a group of military recruits aged 18–35, cardiac anomalies accounted for 51% of cases of SCD, while in 35% of cases the cause remained unknown. Underlying pathology included coronary artery abnormalities (61%), myocarditis (20%), and hypertrophic cardiomyopathy (13%). Congestive heart failure increases the risk of SCD fivefold.
Many additional conduction abnormalities exist that place one at higher risk for cardiac arrest. For instance, long QT syndrome, a condition often mentioned in young people's deaths, occurs in one of every 5000 to 7000 newborns and is estimated to be responsible for 3000 deaths each year compared to the approximately 300,000 cardiac arrests seen by emergency services. These conditions are a fraction of the overall deaths related to cardiac arrest, but represent conditions which may be detected prior to arrest and may be treatable.
About 35% of SCDs are not caused by a heart condition. The most common non-cardiac causes are trauma, bleeding (such as gastrointestinal bleeding, aortic rupture, or intracranial hemorrhage), overdose, drowning and pulmonary embolism. Cardiac arrest can also be caused by poisoning (for example, by the stings of certain jellyfish).
Mnemonic for causes
- Hypovolemia - A lack of blood volume
- Hypoxia - A lack of oxygen
- Hydrogen ions (Acidosis) - An abnormal pH in the body
- Hyperkalemia or Hypokalemia - Both excess and inadequate potassium can be life-threatening.
- Hypothermia - A low core body temperature
- Hypoglycemia or Hyperglycemia - Low or high blood glucose
- Tablets or Toxins
- Cardiac Tamponade - Fluid building around the heart
- Tension pneumothorax - A collapsed lung
- Thrombosis (Myocardial infarction) - Heart attack
- Thromboembolism (Pulmonary embolism) - A blood clot in the lung
- Traumatic cardiac arrest
Cardiac arrest is synonymous with clinical death.
A cardiac arrest is usually diagnosed clinically by the absence of a pulse. In many cases lack of carotid pulse is the gold standard for diagnosing cardiac arrest, but lack of a pulse (particularly in the peripheral pulses) may result from other conditions (e.g. shock), or simply an error on the part of the rescuer. Studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons.
Owing to the inaccuracy in this method of diagnosis, some bodies such as the European Resuscitation Council (ERC) have de-emphasised its importance. The Resuscitation Council (UK), in line with the ERC's recommendations and those of the American Heart Association, have suggested that the technique should be used only by healthcare professionals with specific training and expertise, and even then that it should be viewed in conjunction with other indicators such as agonal respiration.
Various other methods for detecting circulation have been proposed. Guidelines following the 2000 International Liaison Committee on Resuscitation (ILCOR) recommendations were for rescuers to look for "signs of circulation", but not specifically the pulse. These signs included coughing, gasping, colour, twitching and movement. However, in face of evidence that these guidelines were ineffective, the current recommendation of ILCOR is that cardiac arrest should be diagnosed in all casualties who are unconscious and not breathing normally.
With positive outcomes following cardiac arrest unlikely, an effort has been spent in finding effective strategies to prevent cardiac arrest. With the prime causes of cardiac arrest being ischemic heart disease, efforts to promote a healthy diet, exercise, and smoking cessation are important. For people at risk of heart disease, measures such as blood pressure control, cholesterol lowering, and other medico-therapeutic interventions are used.
In medical parlance, cardiac arrest is referred to as a "code" or a "crash". This typically refers to "code blue" on the hospital emergency codes. A dramatic drop in vital sign measurements is referred to as "coding" or "crashing", though coding is usually used when it results in cardiac arrest, while crashing might not. Treatment for cardiac arrest is sometimes referred to as "calling a code".
Extensive research has shown that patients in general wards often deteriorate for several hours or even days before a cardiac arrest occurs. This has been attributed to a lack of knowledge and skill amongst ward-based staff, in particular a failure to carry out measurement of the respiratory rate, which is often the major predictor of a deterioration and can often change up to 48 hours prior to a cardiac arrest. In response to this, many hospitals now have increased training for ward-based staff. A number of "early warning" systems also exist which aim to quantify the risk which patients are at of deterioration based on their vital signs and thus provide a guide to staff. In addition, specialist staff are being utilised more effectively in order to augment the work already being done at ward level. These include:
- Crash teams (or code teams) - These are designated staff members with particular expertise in resuscitation who are called to the scene of all arrests within the hospital. This usually involves a specialized cart of equipment (including defibrillator) and drugs called a "crash cart" or "crash trolley".
- Medical emergency teams - These teams respond to all emergencies, with the aim of treating the patient in the acute phase of their illness in order to prevent a cardiac arrest.
- Critical care outreach - As well as providing the services of the other two types of team, these teams are also responsible for educating non-specialist staff. In addition, they help to facilitate transfers between intensive care/high dependency units and the general hospital wards. This is particularly important, as many studies have shown that a significant percentage of patients discharged from critical care environments quickly deteriorate and are re-admitted; the outreach team offers support to ward staff to prevent this from happening.
In some medical facilities, the resuscitation team may purposely respond slowly to a patient in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the patient's family, a practice known as "show code". This is generally done for patients for whom performing CPR will have no medical benefit. Such practices are ethically controversial, and are banned in some jurisdictions.
Implantable cardioverter defibrillators
A technologically based intervention to prevent further cardiac arrest episodes is the use of an implantable cardioverter-defibrillator (ICD). This device is implanted in the patient and acts as an instant defibrillator in the event of arrhythmia. Note that standalone ICDs do not have any pacemaker functions, but they can be combined with a pacemaker, and modern versions also have advanced features such as anti-tachycardic pacing as well as synchronized cardioversion. A recent study by Birnie et al. at the University of Ottawa Heart Institute has demonstrated that ICDs are underused in both the United States and Canada. An accompanying editorial by Simpson explores some of the economic, geographic, social and political reasons for this. Patients who are most likely to benefit from the placement of an ICD are those with severe ischemic cardiomyopathy (with systolic ejection fractions less than 30%) as demonstrated by the MADIT-II trial.
Sudden cardiac arrest may be treated via attempts at resuscitation. This is usually carried out based upon basic life support (BLS)/advanced cardiac life support (ACLS), pediatric advanced life support (PALS) or neonatal resuscitation program (NRP) guidelines.
Cardiopulmonary resuscitation (CPR) is an important part of the management of cardiac arrest. It is recommended that it be started as soon as possible and interrupted as little as possible. The component of CPR that seems to make the greatest difference in most cases is the chest compressions. Correctly performed bystander CPR has been shown to increase survival; however, it is performed in less than 30% of out of hospital arrests as of 2007. If high-quality CPR has not resulted in return of spontaneous circulation and the person's heart rhythm is in asystole, discontinuing CPR and pronouncing the person's death is reasonable after 20 minutes. Exceptions to this include those with hypothermia or who have drowned. Longer durations of CPR may be reasonable in those who have cardiac arrest while in hospital.
Either a bag valve mask or an advanced airway may be used to help with breathing. High levels of oxygen are generally given during CPR. Tracheal intubation has not been found to improve survival rates in cardiac arrest and in the prehospital environment may worsen it.
CPR which involves only chest compressions results in the same outcomes as standard CPR for those who have gone into cardiac arrest due to heart issues. Mechanical chest compressions (as performed by a machine) are no better than chest compressions performed by hand. It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation.
Shockable and non–shockable causes of cardiac arrest is based on the presence or absence of ventricular fibrillation or pulseless ventricular tachycardia. The shockable rhythms are treated with CPR and defibrillation. In children 2 to 4 J/Kg is recommended.
In addition, there is increasing use of public access defibrillation. This involves placing automated external defibrillators in public places, and training staff in these areas how to use them. This allows defibrillation to take place prior to the arrival of emergency services, and has been shown to lead to increased chances of survival. Some defibrillators even provide feedback on the quality of CPR compressions, encouraging the lay rescuer to press the patient's chest hard enough to circulate blood. In addition, it has been shown that those who have arrests in remote locations have worse outcomes following cardiac arrest.
Medications, while included in guidelines, have not been shown to improve survival to hospital discharge following out-of-hospital cardiac arrest. This includes the use of epinephrine, atropine, lidocaine, and amiodarone. Epinephrine is generally recommended every five minutes. Vasopressin overall does not improve or worsen outcomes compared to epinephrine.
Epinephrine does appear to improve short-term outcomes such as return of spontaneous circulation. Some of the lack of long-term benefit may be related to delays in epinephrine use. While evidence does not support its use in children guidelines state its use is reasonable. Lidocaine and amiodarone are also deemed reasonable in children with cardiac arrest who have a shockable rhythm. The general use of sodium bicarbonate or calcium is not recommended.
The 2010 guidelines from the American Heart Association no longer contain the association's previous recommendation for using atropine in pulseless electrical activity and asystole due to the lack of evidence for its use. Evidence is insufficient for lidocaine, and amiodarone may be considered in those who continue in ventricular tachycardia or ventricular fibrillation despite defibrillation. Thrombolytics when used generally may cause harm but may be of benefit in those with a pulmonary embolism as the cause of arrest.
Targeted temperature management
Cooling adults after cardiac arrest who has a return of spontaneous circulation (ROSC) but no return of consciousness improves outcomes. This procedure is called targeted temperature management (previously known as therapeutic hypothermia). People are typically cooled for a 24-hour period, with a target temperature of 32–36 °C (90–97 °F). Death rates in the hypothermia group are 35% lower than in those with no temperature management. Complications are generally no greater in those who receive this therapy.
Earlier versus later cooling may result in better outcomes. A trial that cooled in the ambulance, however, found no difference compared to starting cooling in-hospital. A registry database found poor neurological outcome increased by 8% with each five-minute delay in initiating TH and by 17% for every 30-minute delay in time to target temperature. In children it is unclear if cooling is beneficial however fever should be prevented.
Do not resuscitate
Some people choose to avoid aggressive measures at the end of life. A do not resuscitate order (DNR) in the form of an advance health care directive makes it clear that in the event of cardiac arrest, the person does not wish to receive cardiopulmonary resuscitation. Other directives may be made to stipulate the desire for intubation in the event of respiratory failure or, if comfort measures are all that are desired, by stipulating that healthcare providers should "allow natural death".
Chain of survival
Several organisations promote the idea of a chain of survival. The chain consists of the following "links":
- Early recognition - If possible, recognition of illness before the patient develops a cardiac arrest will allow the rescuer to prevent its occurrence. Early recognition that a cardiac arrest has occurred is key to survival - for every minute a patient stays in cardiac arrest, their chances of survival drop by roughly 10%.
- Early CPR - improves the flow of blood and of oxygen to vital organs, an essential component of treating a cardiac arrest. In particular, by keeping the brain supplied with oxygenated blood, chances of neurological damage are decreased.
- Early defibrillation - is effective for the management of ventricular fibrillation and pulseless ventricular tachycardia
- Early advanced care
- Early post-resuscitation care
If one or more links in the chain are missing or delayed, then the chances of survival drop significantly.
These protocols are often initiated by a code blue, which usually denotes impending or acute onset of cardiac arrest or respiratory failure, although in practice, code blue is often called in less life-threatening situations that require immediate attention from a physician.
Resuscitation with extracorporeal membrane oxygenation devices has been attempted with better results for in-hospital cardiac arrest (29% survival) than out-of-hospital cardiac arrest (4% survival) in populations selected to benefit most. Cardiac catheterization in those who have survived an out-of-hospital cardiac arrest appears to improve outcomes although high quality evidence is lacking. It is recommended that it is done as soon as possible in those who have had a cardiac arrest due to with ST elevation due to underlying heard problems.
The precordial thump may be considered in those with witnessed, monitored, unstable ventricular tachycardia (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery or be used in those with unwitnessed out of hospital arrest.
The overall chance of survival among those who have cardiac arrest outside of a hospital is 7.6%. Among children rates of survival is 3 to 16% in North America. Prognosis is typically assessed 72 hours or more after cardiac arrest.
Rates of survival are better in those who someone saw collapse, got bystander CPR, or had either ventricular tachycardia or ventricular fibrillation when assessed. Survival among those with Vfib or Vtach is 15 to 23%. Women are more likely to survive cardiac arrest and leave hospital than men.
A 1997 review into outcomes following in-hospital cardiac arrest found a survival to discharge of 14% although the range between different studies was 0-28%. In those over the age of 70 who have a cardiac arrest while in hospital, survival to hospital discharge is less than 20%. How well these individuals are able to manage after leaving hospital is not clear.
A study of survival rates from out-of-hospital cardiac arrest found that 14.6% of those who had received resuscitation by ambulance staff survived as far as admission to hospital. Of these, 59% died during admission, half of these within the first 24 hours, while 46% survived until discharge from hospital. This reflects an overall survival following cardiac arrest of 6.8%. Of these 89% had normal brain function or mild neurological disability, 8.5% had moderate impairment, and 2% had major neurological disability. Of those who were discharged from hospital, 70% were still alive four years later.
Based on death certificates, sudden cardiac death accounts for about 15% of all death in Western countries (330,000 per year in the United States). The lifetime risk is three times greater in men (12.3%) than women (4.2%) based on analysis of the Framingham Heart Study. However this gender difference disappeared beyond 85 years of age.
- Jameson, J. N. St C.; Dennis L. Kasper; Harrison, Tinsley Randolph; Braunwald, Eugene; Fauci, Anthony S.; Hauser, Stephen L; Longo, Dan L. (2005). Harrison's principles of internal medicine. New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-140235-7.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Mallinson, T (2010). "Myocardial infarction". Focus on First Aid (15): 15. Retrieved 2010-06-08.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Safar P (December 1986). "Cerebral resuscitation after cardiac arrest: a review". Circulation. 74 (6 Pt 2): IV138–53. PMID 3536160.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Holzer M, Behringer W (April 2005). "Therapeutic hypothermia after cardiac arrest". Current Opinion in Anesthesiology. 18 (2): 163–8. doi:10.1097/01.aco.0000162835.33474.a9. PMID 16534333.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Safar P, Xiao F, Radovsky A, et al. (January 1996). "Improved cerebral resuscitation from cardiac arrest in dogs with mild hypothermia plus blood flow promotion". Stroke. 27 (1): 105–13. doi:10.1161/01.STR.27.1.105. PMID 8553385.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Rippe, James M.; Irwin, Richard S. (2003). Irwin and Rippe's intensive care medicine. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-3548-3.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- "Resuscitation Council (UK) Guidelines 2005".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Jasmeet Soar, Gavin D. Perkins, Jerry Nolan., eds. (2012). ABC of resuscitation (6th ed.). Chichester, West Sussex: Wiley-Blackwell. p. 43. ISBN 9781118474853.CS1 maint: uses editors parameter (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- "Mount Sinai - Cardiac arrest".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Parnia, S; Spearpoint, K; Fenwick, PB (August 2007). "Near death experiences, cognitive function and psychological outcomes of surviving cardiac arrest". Resuscitation. 74 (2): 215–21. doi:10.1016/j.resuscitation.2007.01.020. PMID 17416449.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Zheng ZJ, Croft JB, Giles WH, Mensah GA (October 2001). "Sudden cardiac death in the United States, 1989 to 1998". Circulation. 104 (18): 2158–63. doi:10.1161/hc4301.098254. PMID 11684624.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Centers for Disease Control and Prevention (CDC) (February 2002). "State-specific mortality from sudden cardiac death--United States, 1999". MMWR Morb. Mortal. Wkly. Rep. 51 (6): 123–6. PMID 11898927.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Eisenberg MS, Mengert TJ (April 2001). "Cardiac resuscitation". N. Engl. J. Med. 344 (17): 1304–13. doi:10.1056/NEJM200104263441707. PMID 11320390.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Kannel WB, Wilson PW, D'Agostino RB, Cobb J (August 1998). "Sudden coronary death in women". Am. Heart J. 136 (2): 205–12. doi:10.1053/hj.1998.v136.90226. PMID 9704680.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Eckart RE, Scoville SL, Campbell CL, et al. (December 2004). "Sudden death in young adults: a 25-year review of autopsies in military recruits". Annals of Internal Medicine. 141 (11): 829–34. doi:10.7326/0003-4819-141-11-200412070-00005. PMID 15583223.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Sudden Cardiac Death
- Kuisma M, Alaspää A (July 1997). "Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome". Eur. Heart J. 18 (7): 1122–8. doi:10.1093/oxfordjournals.eurheartj.a015407. PMID 9243146.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Friedlander Y, Siscovick DS, Weinmann S, et al. (January 1998). "Family history as a risk factor for primary cardiac arrest". Circulation. 97 (2): 155–60. doi:10.1161/01.cir.97.2.155. PMID 9445167.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- ECC Committee, Subcommittees and Task Forces of the American Heart Association (December 2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 112 (24 Suppl): IV1–203. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I (June 1998). "Competence of health professionals to check the carotid pulse". Resuscitation. 37 (3): 173–5. doi:10.1016/S0300-9572(98)00055-0. PMID 9715777.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Bahr J, Klingler H, Panzer W, Rode H, Kettler D (August 1997). "Skills of lay people in checking the carotid pulse". Resuscitation. 35 (1): 23–6. doi:10.1016/S0300-9572(96)01092-1. PMID 9259056.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- British Red Cross; St Andrew's Ambulance Association; St John Ambulance (2006). First Aid Manual: The Authorised Manual of St. John Ambulance, St. Andrew's Ambulance Association, and the British Red Cross. Dorling Kindersley Publishers Ltd. ISBN 1-4053-1573-3.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K (September 2004). "A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study". Resuscitation. 62 (3): 275–82. doi:10.1016/j.resuscitation.2004.05.016. PMID 15325446.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- "Slow Codes, Show Codes and Death". New York Times. New York Times Company. 22 August 1987. Retrieved 2013-04-06.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- "Decision-making for the End of Life". Physician Advisory Service. College of Physicians and Surgeons of Ontario. May 2006. Retrieved 2013-04-06.CS1 maint: others (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- DePalma, Judith A.; Miller, Scott; Ozanich, Evelyn; Yancich, Lynne M. (November 1999). "Slow" Code: Perspectives of a Physician and Critical Care Nurse. Critical Care Nursing Quarterly. 22. Lippincott Williams and Wilkins. pp. 89–99. ISSN 1550-5111.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Birnie, David H; Sambell, Christie; Johansen, Helen; Williams, Katherine; Lemery, Robert; Green, Martin S; Gollob, Michael H; Lee, Douglas S; Tang, Anthony SL (July 2007). "Use of implantable cardioverter defibrillators in Canadian and IS survivors of out-of-hospital cardiac arrest". Canadian Medical Association Journal. 177 (1): 41–6. doi:10.1503/cmaj.060730. PMC 1896034. PMID 17606938. Retrieved 2007-07-29.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Simpson CS (July 2007). "Implantable cardioverter defibrillators work--so why aren't we using them?". CMAJ. 177 (1): 49–51. doi:10.1503/cmaj.070470. PMC 1896028. PMID 17606939.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Moss AJ, Brown MW, Cannom DS, et al. (October 2005). "Multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT): design and clinical protocol". Ann Noninvasive Electrocardiol. 10 (4 Suppl): 34–43. doi:10.1111/j.1542-474X.2005.00073.x. PMID 16274414.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- American Heart, Association (May 2006). "2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support". Pediatrics. 117 (5): e1005–28. doi:10.1542/peds.2006-0346. PMID 16651281.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Mutchner L (January 2007). "The ABCs of CPR--again". Am J Nurs. 107 (1): 60–9, quiz 69–70. doi:10.1097/00000446-200701000-00024. PMID 17200636.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Resuscitation Council (UK). "Pre-hospital cardiac arrest" (PDF). www.resus.org.uk. p. 41. Retrieved 3 September 2014.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Resuscitation Council (UK) (5 September 2012). "Comments on the duration of CPR following the publication of 'Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study' Goldberger ZD et al. Lancet". Retrieved 3 September 2014.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Neumar, RW; Shuster, M; Callaway, CW; Gent, LM; Atkins, DL; Bhanji, F; Brooks, SC; de Caen, AR; Donnino, MW; Ferrer, JM; Kleinman, ME; Kronick, SL; Lavonas, EJ; Link, MS; Mancini, ME; Morrison, LJ; O'Connor, RE; Samson, RA; Schexnayder, SM; Singletary, EM; Sinz, EH; Travers, AH; Wyckoff, MH; Hazinski, MF (3 November 2015). "Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S315-67. PMID 26472989.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Studnek JR, Thestrup L, Vandeventer S, et al. (September 2010). "The association between prehospital endotracheal intubation attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients". Acad Emerg Med. 17 (9): 918–25. doi:10.1111/j.1553-2712.2010.00827.x. PMID 20836771.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Yao, L; Wang, P; Zhou, L; Chen, M; Liu, Y; Wei, X; Huang, Z (Jun 2014). "Compression-only cardiopulmonary resuscitation vs standard cardiopulmonary resuscitation: an updated meta-analysis of observational studies". The American journal of emergency medicine. 32 (6): 517–23. doi:10.1016/j.ajem.2014.01.055. PMID 24661781.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Huang, Y; He, Q; Yang, LJ; Liu, GJ; Jones, A (Sep 12, 2014). "Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest". The Cochrane database of systematic reviews. 9: CD009803. doi:10.1002/14651858.CD009803.pub2. PMID 25212112.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- de Caen, AR; Berg, MD; Chameides, L; Gooden, CK; Hickey, RW; Scott, HF; Sutton, RM; Tijssen, JA; Topjian, A; van der Jagt, ÉW; Schexnayder, SM; Samson, RA (3 November 2015). "Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S526-42. PMID 26473000.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Zoll AED Plus
- Lyon R.M, Cobbe S.M., Bradley J.M., Grubb N.R.; et al. (2004). "Surviving out of hospital cardiac arrest at home: a postcode lottery?". Emergency Medical Journal. 21: 619–624. doi:10.1136/emj.2003.010363.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L (November 2009). "Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial". JAMA. 302 (20): 2222–9. doi:10.1001/jama.2009.1729. PMID 19934423.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Lin, S; Callaway, CW; Shah, PS; Wagner, JD; Beyene, J; Ziegler, CP; Morrison, LJ (Mar 15, 2014). "Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials". Resuscitation. 85 (6): 732–40. doi:10.1016/j.resuscitation.2014.03.008. PMID 24642404.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Morley, PT (June 2011). "Drugs during cardiopulmonary resuscitation". Current Opinion in Critical Care. 17 (3): 214–8. doi:10.1097/MCC.0b013e3283467ee0. PMID 21499094.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Attaran, RR; Ewy, GA (July 2010). "Epinephrine in resuscitation: curse or cure?". Future cardiology. 6 (4): 473–82. doi:10.2217/fca.10.24. PMID 20608820.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Neumar, RW; Otto, CW; Link, MS; Kronick, SL; Shuster, M; Callaway, CW; Kudenchuk, PJ; Ornato, JP; McNally, B; Silvers, SM; Passman, RS; White, RD; Hess, EP; Tang, W; Davis, D; Sinz, E; Morrison, LJ (Nov 2, 2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729-67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Ong, ME; Pellis, T; Link, MS (June 2011). "The use of antiarrhythmic drugs for adult cardiac arrest: a systematic review". Resuscitation. 82 (6): 665–70. doi:10.1016/j.resuscitation.2011.02.033. PMID 21444143.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Perrott, J; Henneberry, RJ; Zed, PJ (December 2010). "Thrombolytics for cardiac arrest: case report and systematic review of controlled trials". Annals of Pharmacotherapy. 44 (12): 2007–13. doi:10.1345/aph.1P364. PMID 21119096.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Xiao, G; Guo, Q; Shu, M; Xie, X; Deng, J; Zhu, Y; Wan, C (February 2013). "Safety profile and outcome of mild therapeutic hypothermia in patients following cardiac arrest: systematic review and meta-analysis". Emergency medicine journal : EMJ. 30 (2): 91–100. doi:10.1136/emermed-2012-201120. PMID 22660549.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wise, Matt P.; Åneman, Anders; Al-Subaie, Nawaf; Boesgaard, Søren; Bro-Jeppesen, John; Brunetti, Iole; Bugge, Jan Frederik; Hingston, Christopher D.; Juffermans, Nicole P.; Koopmans, Matty; Køber, Lars; Langørgen, Jørund; Lilja, Gisela; Møller, Jacob Eifer; Rundgren, Malin; Rylander, Christian; Smid, Ondrej; Werer, Christophe; Winkel, Per; Friberg, Hans (17 November 2013). "Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest". New England Journal of Medicine. 369 (23): 131117131833001. doi:10.1056/NEJMoa1310519. PMID 24237006.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Arrich, J; Holzer, M; Havel, C; Müllner, M; Herkner, H (Sep 12, 2012). "Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation". Cochrane database of systematic reviews (Online). 9: CD004128. doi:10.1002/14651858.CD004128.pub3. PMID 22972067.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Stockmann, H; Krannich, A; Schroeder, T; Storm, C (November 2014). "Therapeutic temperature management after cardiac arrest and the risk of bleeding: Systematic review and meta-analysis". Resuscitation. 85 (11): 1494–1503. doi:10.1016/j.resuscitation.2014.07.018. PMID 25132475.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Dell'anna, AM; Scolletta, S; Donadello, K; Taccone, FS (June 2014). "Early neuroprotection after cardiac arrest". Current opinion in critical care. 20 (3): 250–8. doi:10.1097/mcc.0000000000000086. PMID 24717694.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Sendelbach, S; Hearst, MO; Johnson, PJ; Unger, BT; Mooney, MR (July 2012). "Effects of variation in temperature management on cerebral performance category scores in patients who received therapeutic hypothermia post cardiac arrest". Resuscitation. 83 (7): 829–34. doi:10.1016/j.resuscitation.2011.12.026. PMID 22230942.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Loertscher, L; Reed, DA; Bannon, MP; Mueller, PS (January 2010). "Cardiopulmonary resuscitation and do-not-resuscitate orders: a guide for clinicians". The American Journal of Medicine. 123 (1): 4–9. doi:10.1016/j.amjmed.2009.05.029. PMID 20102982.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Knox, C; Vereb, JA (December 2005). "Allow natural death: a more humane approach to discussing end-of-life directives". Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association. 31 (6): 560–1. doi:10.1016/j.jen.2005.06.020. PMID 16308044.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Lehot, JJ; Long-Him-Nam, N; Bastien, O (December 2011). "[Extracorporeal life support for treating cardiac arrest]". Bulletin de l'Academie nationale de medecine. 195 (9): 2025–33, discussion 2033-6. PMID 22930866.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Camuglia, AC.; Randhawa, VK.; Lavi, S.; Walters, DL. (Sep 2014). "Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: Review and meta-analysis". Resuscitation. 85: 1533–1540. doi:10.1016/j.resuscitation.2014.08.025. PMID 25195073.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Cave, DM; Gazmuri, RJ; Otto, CW; Nadkarni, VM; Cheng, A; Brooks, SC; Daya, M; Sutton, RM; Branson, R; Hazinski, MF (2010-11-02). "Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S720-8. doi:10.1161/CIRCULATIONAHA.110.970970. PMC 3741663. PMID 20956223.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Sasson, C; Rogers, MA; Dahl, J; Kellermann, AL (January 2010). "Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis". Circulation. Cardiovascular quality and outcomes. 3 (1): 63–81. doi:10.1161/circoutcomes.109.889576. PMID 20123673.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Bougouin, W; Mustafic, H; Marijon, E; Murad, MH; Dumas, F; Barbouttis, A; Jabre, P; Beganton, F; Empana, JP; Celermajer, DS; Cariou, A; Jouven, X (September 2015). "Gender and survival after sudden cardiac arrest: A systematic review and meta-analysis". Resuscitation. 94: 55–60. doi:10.1016/j.resuscitation.2015.06.018. PMID 26143159.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Ballew KA (May 1997). "Cardiopulmonary resuscitation". BMJ. 314 (7092): 1462–5. doi:10.1136/bmj.314.7092.1462. PMC 2126720. PMID 9167565.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- van Gijn, MS; Frijns, D; van de Glind, EM; C van Munster, B; Hamaker, ME (Jul 2014). "The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review". Age and ageing. 43 (4): 456–63. doi:10.1093/ageing/afu035. PMID 24760957.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- Cobbe SM, Dalziel K, Ford I, Marsden AK (June 1996). "Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest". BMJ. 312 (7047): 1633–7. doi:10.1136/bmj.312.7047.1633. PMC 2351362. PMID 8664715.CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
- "Abstract 969: Lifetime Risk for Sudden Cardiac Death at Selected Index Ages and by Risk Factor Strata and Race: Cardiovascular Lifetime Risk Pooling Project -- Lloyd-Jones et al. 120 (10018): S416 -- Circulation".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
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